temocillin versus a carbapenem as initial intravenous treatment for esbl related urinary tract infections

Conditions: Urinary Tract Infections

Summary: temo-carb is a phase 3, randomized, controlled, multicentre, open-label pragmatic clinical trial to test the non-inferiority of temocillin versus carbapenem as initial intravenous treatment of urinary tract infection (uti) due to extended-spectrum beta-lactamase (esbl) producing enterobacteriaceae.

urinary tract infections are among the most common bacterial infections that are treated in the community by an empirical antibiotic treatment regimen. enterobacteriaceae are the most common bacteria involved in urinary tract infection. since 2006, extended-spectrum beta-lactamase (esbl) producing enterobacteriaceae have spread in france, as elsewhere. finding therapeutic alternatives to carbapenems in infections caused by esbl producing enterobacteriaceae is imperative. although temocillin, 6-α-methoxy derivative of ticarcillin has been suggested as a potential alternative to carbapenem therapy for esbl related infections, it was not investigated in accordance with current standard. the hypothesis to test in this study is that temocillin is not inferior to a carbapenem as initial intravenous treatment of urinary tract infections caused by esbl producing enterobacteriaceae.

Eligibility criteria:
inclusion criteria: * adult (≥ 18 years) * hospitalized patient with clinically significant monomicrobial uti * complicated uti due to esbl producing enterobacteriaceae (pyelonephritis, prostatitis or renal abscess) requiring parenteral antimicrobial therapy * susceptibility to temocillin and carbapenem as evidenced by testing results * for woman able to procreate: negative pregnancy test and use of an effective method of contraception (abstinence, oral contraceptives, intra-uterine device, diaphragm with spermicide and condom). all forms of hormonal contraception are acceptable * signed informed consent by patient himself (able or under curatorship) or his legal representative (patient unable to give his consent or under tutorship) * patient affiliated to the social security system exclusion criteria: * patient infected with a bacteria which is not an esbl-producing enterobacteriaceae. * polymicrobial infection. * hypersensitivity and/or previous intolerance to carbapenem or temocillin, or penicillins or any other beta-lactam. * patient with a contraindication to any of the drugs to be used in research * patient presenting another site of infection than urinary (except onset of bacteraemia from urinary tract origin due to gram negative bacteria). * woman who is pregnant, breastfeeding, or expecting to conceive at any time during the study (pregnancy test will be conducted for woman without menopause). * palliative care of life expectancy \< 90 days. * ongoing empirical treatment of the urinary tract infections with carbapenem or temocillin \> 24 hours before randomization * delay in randomization \> 48 hours after identification of esbl producing enterobacteriaceae in urinary and/or blood culture. * participation in other clinical trial for the infection.

Keywords: non-inferiority study temocillin carbapenem esbl infection urinary tract infection